Health - Drinking - beyond a joke

Excess alcohol intake in the UK is now of epidemic proportions, but what can - and should - be done about it?

Dr Trisha Greenhalgh.

How much alcohol did you drink yesterday? If you're British and typical, probably too much. This was the essence of the British Medical Association (BMA) Board of Science's latest report on alcohol misuse, published last month on

The report confirmed what many of us suspected - that excess alcohol intake in the UK is now of epidemic proportions (we drink two and a half times as much alcohol as we did in the 1950s), and is associated with high levels of premature sickness and death, as well as domestic and other violence, antisocial behaviour, crime, and a huge amount of unhappiness. No surprises there - but what is to be done about it? The BMA recommends tough measures - reduced opening hours of licensed premises, higher taxes on alcohol, a lowering of the drink-driving limit (form 80 to 50 mmol/L), random roadside breath testing (even if the police officer has no specific reason to suspect that the person is over the limit), tobacco-style health warnings on bottles, and 'opportunistic testing' by GPs of people who walk (or stagger) into their surgeries with an air of inebriation about them.

Children in particular, especially girls, are drinking far too much. My own teenagers, who thankfully have yet to develop a taste for booze themselves, are ghoulishly entertained by docudrama footage of 'ladette' behaviour by their contemporaries. 'It's just funny,' they say, confirming the BMA's conclusion that alcohol misuse is now 'an integral part of modern culture'. But my children have never had to manage a 19-year-old who has made himself diabetic by destroying his pancreas with alcohol, or prescribe immunosuppressive drugs to a 24-year-old following a liver transplant for cirrhosis.

Protection required

According to the BMA, the young need protecting from themselves - by measures such as reducing the opening hours of licensed premises, making it more difficult to get a licence to sell alcohol in the first place, restricting advertising on alcohol (especially at times when young people may be watching TV), setting a minimum price for all alcoholic drinks, and raising the tax on alcohol at a rate substantially higher than the rate of inflation. As an editorial in the British Medical Journal pointed out recently, the affordability of alcohol (price in relation to income and adjusted for inflation) in the UK rose by 65% from 1980 to 2006.

While the BMA is confident that 24-hour licensing (introduced two years ago) is contributing to the alcohol misuse epidemic, the government's official evaluation of the 2005 Licensing Act comes to the opposite conclusion. Remarkably few people, it claims, have turned to 24-hour drinking - though the report acknowledges that a small fraction now regularly stay up till the small hours making a nuisance of themselves. Tellingly, the government's evaluation is published not by the Department of Health but by the Department of Culture, Media and Sport, and makes much of 'positive partnerships' with the hospitality and entertainment industry and of the 'flexibility' for responsible citizens to enjoy themselves in different ways and on special occasions.

This schizophrenic policymaking reflects the ambivalent relationship that many of us have with alcohol (we see alcohol as 'good' for us but 'bad' for certain other people). As well as being a psychoactive drug that some but not all working-class youth use irresponsibly, alcohol is also a great way of relaxing for the middle-aged, the educated and the posh. It has huge symbolic meaning in society - we launch ships with it; we wet the baby's head with it at christenings; and we even sip it on our knees at the communion rail. When I'm savouring the latest delivery from the Wine Society I find it hard to believe that I'm enjoying the same physical, mental and emotional influences as the underdressed young women vomiting into the gutter on Holiday from Hell.

The widespread unwillingness to link the problems of alcohol with the drug itself rather than a particular social use of it has been one of the reasons why alcohol control measures remain relatively slack compared with, say, those on tobacco or illegal drugs. Perhaps, then, the BMA is right when it recommends that it should be a legal requirement to display a common standard label on all alcoholic products clearly stating the alcohol content, recommended daily UK consumption guidelines, and a warning that exceeding these guidelines may cause harm.

The problem with this would be that you and I wouldn't want to see messages such as: 'DRINKING WHILE PREGNANT CAN MAKE YOUR BABY MENTALLY RETARDED', ruining the gold lettering on our vintage claret. But perhaps, for our children's sake, we should support such a measure.

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